Role Description
This role involves verifying insurance eligibility and benefits for services, ensuring compliance with payor requirements, and communicating financial responsibilities to patients.
• Verifies insurance eligibility and benefits for scheduled and unscheduled services
• Calculates and communicates the patient’s estimated financial responsibility for scheduled services
• Identifies and ensures authorization and referral requirements are met in accordance with payor guidelines
• Validates and documents all authorizations and referrals according to established policies
• Reviews and determines the medical necessity of scheduled services based on payor criteria
• Accurately documents and maintains all required records and communications in compliance with organizational standards
• Communicates effectively and professionally with patients, physicians, and medical office staff to resolve inquiries
• Educates patients on insurance coverage, benefits, and financial responsibility
• Processes and indexes incoming orders promptly and ensures compliance with documentation standards
• Provides timely notification of admission or observation status per payor guidelines for inpatient and observation services
• Performs other duties as assigned
• Complies with all policies and standards
Company Description